Provider Demographics
NPI:1174676225
Name:WEISS, NITZA (PHD)
Entity Type:Individual
Prefix:DR
First Name:NITZA
Middle Name:
Last Name:WEISS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 BARDINI DRIVE
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-5326
Mailing Address - Country:US
Mailing Address - Phone:516-982-3030
Mailing Address - Fax:631-425-1360
Practice Address - Street 1:399 CONKLIN STREET
Practice Address - Street 2:SUITE 305
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-2614
Practice Address - Country:US
Practice Address - Phone:516-982-3030
Practice Address - Fax:631-425-1360
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008488103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P625941OtherOXFORD
P625941OtherOXFORD
NYV23981Medicare UPIN